Percutaneous core needle biopsy for para-aortic retroperitoneal lesions: impact of size and location on diagnostic accuracy of computed tomography-guided biopsy and feasibility of ultrasound guidance.

AIM

To evaluate the safety and efficacy of computed tomography (CT)-guided core needle biopsy (CNB) for para-aortic retroperitoneal lesions, identify factors affecting false-negative results, and explore the feasibility of alternative CT-guided and ultrasound-guided approaches for challenging anatomical regions.

MATERIALS AND METHODS

This single-institution retrospective study included 317 consecutive patients who underwent CNB for para-aortic retroperitoneal lesions. A total of 345 biopsies were performed using 18-gauge cutting needles under CT or ultrasound guidance. Diagnostic accuracy was calculated based on biopsy and follow-up results, and univariate analysis was performed to identify predictors of false-negative CT-guided biopsies.

RESULTS

Of the 332 CT-guided biopsies, 203 targeted lateral aortic lesions. The standard posterior paravertebral approach was commonly used; complex cases requiring alternative CT- or ultrasound-guided approaches involved pre-aortocaval or inter-aortocaval lesions. In CT-guided biopsies, 5 of the 30 lesions in these regions were accessed via trans-caval, trans-pedicle, or trans-disc approaches. All 13 ultrasound-guided biopsies were performed with anterior access except for 2 cases. Malignant lymphoma and nodal metastasis were the most common pathologic findings. Overall sensitivity, specificity, and accuracy were 96.7%, 100%, and 97%, respectively. Neither lesion size nor location predicted false-negative CT-guided biopsies with similar accuracy for lesions ≤15 mm (98.4%) and >15 mm (96.9%). Major bleeding occurred in two CT-guided biopsies (0.6%).

CONCLUSION

CT-guided CNB demonstrated high diagnostic accuracy across all lesion locations, particularly with the standard posterior paravertebral approach. For more challenging pre-aortocaval or inter-aortocaval lesions, alternative CT-guided posterior or ultrasound-guided anterior approaches may help overcome anatomical constrains and expand percutaneous options.